Patho Puzzler: Addison disease: The importance of early diagnosis
Carmel T. Ficorelli MSN, RN, FNP

Nursing Made Incredibly Easy!
April 2013 
Volume 11  Number 2
Pages 11 - 15
  PDF Version Available!

Mr. F is a 44-year-old White man who has a history of Hashimoto thyroiditis. He reports progressive fatigue over the past 6 months and has developed nausea, vomiting, anorexia, and weight loss over the past several weeks. On physical assessment, his skin has a bronze tone. Mr. F's lab values are: sodium, 132 mEq/L; potassium, 5.6 mEq/L; blood urea nitrogen (BUN), 18 mg/dL; and creatinine, 1.1mg/dL. He also reports shortness of breath when ambulating short distances. He denies chest pain, fever, chills, cough, night sweats, or dysuria. You suspect Addison disease-a rare, chronic endocrine disorder.The adrenal glands consist of an outer portion (cortex) and an inner portion (medulla). The cortex produces three types of hormones: glucocorticoids (such as cortisol) maintain glucose control, suppress immune response, and help the body respond to stress; mineralocorticoids (such as aldosterone) regulate sodium and potassium balance; and sex hormones (androgens [male] and estrogens [female]) affect sexual development and sex drive. These glands are located just above the kidneys. If the adrenal glands are unable to produce sufficient steroid hormones such as glucocorticoids and often mineralocorticoids, Addison disease, or chronic hypocortisolism, occurs (see Adrenal hypofunction).Autoimmune Addison disease is the most frequent etiologic form in adult patients, accounting for about 80% of cases, followed by posttuberculosis Addison disease in 10% to 15% of patients. The remaining 5% of cases are due to vascular, neoplastic, or rare genetic forms. In autoimmune Addison disease, the immune system mistakenly attacks the patient's own tissues, damaging the adrenal glands. The most common cause of this condition is an autoimmune disease; other causes include tuberculosis and chronic infection. Addison disease can be treated and controlled with medication, but can't be cured. Early recognition of adrenal insufficiency is essential to avoid associated morbidity and mortality. Initial

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